borang bps i permohonan penubuhan institusi...

BORANG BPS I FORM BPS I

BORANG BPS I

Kementerian Pelajaran Malaysia Bahagian Pendidikan Swasta, Aras 3, Blok E2, Kompleks E, Pusat Pentadbiran Kerajaan Persekutuan, 62604 W. P. Putrajaya

Tel: 03 8884 9536/9571 Fax: 03 8888 6676 Website: http://www.moe.gov.my/bps 1

KEMENTERIAN PELAJARAN MALAYSIA

MINISTRY OF EDUCATION, MALAYSIA BAHAGIAN PENDIDIKAN SWASTA

PRIVATE EDUCATION MALAYSIA ARAS 3, BLOK E2, KOMPLEKS E

PUSAT PENTADBIRAN KERAJAAN PERSEKUTUAN 62604 W.P. PUTRAJAYA

Tel: 03-8884 9536/9571 Fax: 03-8888 6676/6679 PERINGATAN : NOTE

Permohonan yang TIDAK lengkap, tidak akan di proses Incomplete application will not be processed Rujuk senarai semak yang dilampirkan

Please refer to the checklist attached

Sertakan kertas berasingan jika ruang yang disediakan tidak mencukupi Attach a separate write-up if space is insufficient

Semua maklumat perlu dilengkapkan All information must be completed

BIL No

JENIS TYPE

TANDA TICK (√)

BIL No

JENIS TYPE

TANDA TICK (√)

1. Sekolah Rendah Primary School 10. Pusat Bahasa

Language Centre

2. Sekolah Menengah Secondary School 11. Pusat Latihan Komputer

Computer Training Centre

3. Sekolah Rendah Agama Islam Islamic Primary School

12. Pusat Kemahiran Skill Centre

4. Sekolah Menengah Agama Islam Islamic Secondary School

13. Pusat Vokasional/Teknikal Vocational/Technical Centre

5. Sekolah Antarabangsa International School 14. Pusat Perkembangan Minda

Mind Enrichment Centre

6. Sekolah Ekspatriat Expatriate School 15. Pusat Bimbingan

Guidance Centre

7. Sekolah Pendidikan Khas Special Education School 16.

Cawangan (Namakan IPS Induk) Branch (Name the main PEI) .....................................................

8. Tadika Kindergarten 17.

Lain-lain IPS (Nyatakan) Other PEI (Please state) ..............................................

9. Pusat Tuisyen Tuition Centre

Tandakan (√) pada petak berkenaan. Satu permohonan bagi SATU kategori institusi sahaja Tick (√) the relevant box. One application for each category

PERMOHONAN PENUBUHAN INSTITUSI PENDIDIKAN SWASTA (IPS)

APPLICATION FOR THE ESTABLISHMENT OF PRIVATE EDUCATIONAL INSTITUTION (PEI)

BAHAGIAN A : KATEGORI INSTITUSI PENDIDIKAN SWASTA (IPS) YANG DIPOHON SECTION A : CATEGORY OF PRIVATE EDUCATIONAL INSTITUTION (PEI)


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BAHAGIAN B : MAKLUMAT PEMOHON SECTION B : APPLICANT’S INFORMATION 1. Butiran Pemohon

Particulars of Applicant

a) Nama pemohon seperti di dalam Kad Pengenalan (KP)/Pasport Name of applicant as in the Identity Card (IC)/Passport

b) No. Kad Pengenalan Identity Card No. Lama Old

Baru New

_

_

Sertakan salinan Kad Pengenalan/Pasport yang disahkan Attach certified copy of Identity Card/Passport

c) No. Pasport Passport No.

d) Alamat surat-menyurat Correspondence Address

Poskod

Postcode

e) No Telefon Telephone No. _

f) No. Telefon Bimbit Mobile No. _

g) No. Faks Fax No.

_

h) E-mel

E-mail


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BAHAGIAN C : RASIONAL PENUBUHAN SECTION C : RATIONALE FOR ESTABLISHMENT

Nyatakan sebab-sebab penubuhan Please state reasons for establishment

____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

1. Permohonan daripada pendaftaran perniagaan/syarikat/pertubuhan/persatuan/yayasan /koperasi, nyatakan butir-butir berikut :

Application from registrar of business/company/organisation/society/foundation/cooperative, state the following details:

a) Entiti pemohon Type of entity

BIL. No.

STATUS STATUS

TANDA TICK (√)

1. Daftar Perniagaan: Tunggal Business Registration: Sole Proprietor

Nota: Note:

2. Daftar Perniagaan: Perkongsian Business Registration: Partnership

** **

Bagi IPS kecuali tadika, pusat tuisyen dan pusat perkembangan minda (francaisi), pemohon hendaklah berstatus Syarikat Sdn. Bhd., Syarikat Berhad, Pertubuhan / Persatuan atau Yayasan/Koperasi sahaja For PEI except kindergarten, tuition centre and mind enrichment centre (franchisee),the status of the applicant must be that of Private Limited Company, Organisation / Society or Foundation / Cooperative only

3. Syarikat Sdn. Bhd. Private Limited Company

4. Syarikat Berhad Limited Company

5. Pertubuhan/Persatuan Organisation/Society

6. Yayasan/Koperasi Foundation/Cooperative

Tandakan (√) pada petak berkenaan Tick (√) the relevant box

b) Nama pendaftaran perniagaan/syarikat/pertubuhan/persatuan/yayasan/koperasi

Name of registrar of business/company/organisation/society/foundation/cooperative

BAHAGIAN D : MAKLUMAT PERNIAGAAN SECTION D : BUSINESS INFORMATION


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c) Alamat berdaftar pendaftaran perniagaan/syarikat/pertubuhan/persatuan/yayasan/koperasi Address of registrar of business/company/organisation/society/foundation/cooperative

Poskod Postcode

d) Alamat surat-menyurat

Correspondence address

Poskod Postcode

e) Tarikh didaftarkan Registration date

(hh) (dd)

(bb) (mm)

(tttt) (yyyy)

f) No. Pendaftaran perniagaan/syarikat/pertubuhan/persatuan/yayasan/koperasi Registration No. of registrar of business/company/organisation/society/foundation/cooperative

Sertakan salinan Sijil Pendaftaran perniagaan/syarikat/pertubuhan/persatuan/yayasan/koperasi Attach a copy of Registration Certificate of business / company / organisation / society / foundation / cooperative

g) Modal Dibenarkan Authorized capital

R M . 0 0

h) Modal Berbayar Paid-up capital

R M . 0 0 Sertakan salinan Borang 24 Akta Syarikat 1965 dan Laporan Kewangan yang diaudit

Include a copy of Form 24 of Company Act 1965 and latest audited financial report

i) Sumber kewangan institusi (jika perniagaan/pertubuhan/persatuan/yayasan/koperasi) Source of Finance (if a business/society/society/foundation/cooperative)

Bil. No.

Sumber Source

Amaun (RM) Amount (RM)

Sertakan salinan terkini Akaun Bank/Laporan Kewangan Tahunan Include a copy of the latest Bank Statement/Annual Financial Report


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j) Pemegang Saham Shareholders

k) Lembaga Pengarah Syarikat

Company’s Board of Directors Bil. No.

Nama Penuh Full Name

Warganegara Nationality

Profesion Profession

1. Nama/Name: No. K.P/Pasport: I.C/Passport No

2.

3.

4.

5.

Sertakan salinan M&A dan Borang 49 Akta Syarikat 1965 Include a copy of the M & A and Form 49 of the Company’s Act 1965

l) Senarai Ahli Jawatankuasa (Jika pertubuhan/persatuan/yayasan/koperasi)

List of Committee Members (if organisation/society/foundation/cooperative)

Bil. No.

Nama Penuh Warganegara

Full Name Nationality

Alamat Address

Profesion Profession

Jawatan Disandang Dalam

Pertubuhan/Persatuan/Yayasan/Koperasi

Position Held in Organisation / Society /

Foundation / Cooperative


2.

3.

4.

5.

Bil. No.


Warganegara Nationality

Bangsa Race

Saham Share

Amaun(RM) Amount

Peratus (%)

Percentage


2.

3.

4.

5.


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BAHAGIAN E : MAKLUMAT INSTITUSI PENDIDIKAN YANG AKAN DITUBUHKAN SECTION E : EDUCATIONAL INSTITUTION’S INFORMATION

1. Maklumat Institusi Pendidikan Particulars of Educational Institution

a) Cadangkan tiga nama Suggest 3 names

1.

2.

3.

b) Alamat Institusi Pendidikan Address of Educational Institution

Poskod Postcode

c) Sertakan peta lokasi Include the location map

NOTA : Note 1. Bagi kategori sekolah, kemukakan surat sokongan bagi mengadakan aktiviti pendidikan

oleh Pihak Berkuasa Tempatan (PBT) For school category, submit a letter of support for conducting education activity from the relevant local authority/council

2. Bagi kategori tadika, kemukakan surat persetujuan jiran-jiran yang terdekat/surat sokongan Pihak Berkuasa Tempatan (PBT) For kindergarten category, submit neighbourhood agreement/letter of support from the relevant local authority/council

d) Sesi Pembelajaran Learning Session

Waktu Time

Tanda Tick (√ )

Masa Pembelajaran Learning Hours

Pagi Morning ______ hingga

till ______

Petang Evening ______ hingga

till ______

Malam Night ______ hingga

till ______ Tandakan (√) pada petak yang berkenaan dan tuliskan masa pembelajaran Tick (√) the relevant box and state the learning hours


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e) Bahasa Pengantar Medium of Instruction

TADIKA LAIN-LAIN IPS KINDERGARTEN OTHER PEI

1. Bahasa Kebangsaan National Language

1. Bahasa Kebangsaan National Language

2. Bahasa Inggeris English Language

2. Bahasa Inggeris English Language

3. Mandarin Mandarin

3. Lain-lain, nyatakan Others, please state .........................................

4. Bahasa Tamil Tamil

5. Lain-lain, nyatakan Others, please state .................................

Tandakan (√) pada petak berkaitan Tick (√) the relevant box

BAHAGIAN F : PENGURUSAN SECTION F : MANAGEMENT

1. Maklumat Ahli Lembaga Pengelola

Particulars of Board of Governors

a) Maklumat Ahli Lembaga Pengelola (ALP) (Minimum 3 orang untuk Tadika/Pusat Tuisyen atau 5 orang untuk lain-lain IPS) Board of Governors (BoG) Details (Minimum of 3 person for Kindergarten/Tuition Centre or 5 person for other PEI)

Bil No


Warganegara

Citizenship Profesion Profession

Pengerusi: Chairman:

1. Nama/Name: No. K.P/Pasport: I.C/Passport No.

Ahli-Ahli: Members:

2. Nama/Name: No. K.P/Pasport: I.C/Passport No.

3.

4.

5.

NOTA : Note 1. Pengerusi ALP mestilah warganegara Malaysia

The chairman of the BoG must be a Malaysian

2. Pengetua/Guru Besar tidak boleh dilantik sebagai ALP kerana ia bertindak sebagai setiausaha kepada ALP The Principal/Headmaster acts as a secretary to the BoG, thus he/she cannot be appointed as a member of the BoG


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2. Malumat Guru Besar/Pengetua Particulars of Headmaster/ Principal

- Sila lampirkan Curriculum Vitae (CV) Please attach Curriculum Vitae (CV)

a) Nama penuh mengikut Kad Pengenalan/Pasport Full name as in Identity Card/Passport

b) No. Kad Pengenalan Identity Card No. Lama Old

Baru New

_

_

c) No. Pasport Passport No.

Sertakan salinan kad pengenalan/pasport yang disahkan. Attach certified copy of Identity Card/Passport

d) Warganegara Citizenship

e) Kelulusan Akademik f) Kelulusan Ikhtisas Academic Qualification Profesional Qualification

Sertakan salinan sijil-sijil yang disahkan Attach certified copies of certificates

g) Pengalaman Dalam Bidang Pendidikan j) Pengalaman Dalam Bidang Pengurusan Experience in the Field of Education Experience in the Field of Management

Bil No

Jawatan Position

Tempoh Duration Bil

No Jawatan Position

Tempoh Duration

1. 1.

2. 2.

3. 3.

4. 4.


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3. Maklumat Guru Particulars of Teachers

4. Maklumat Staf Bukan Akademik

Particulars of Non Academic Staff Bil. No.


No. K.P/ Pasport

I.C/Passport No.

Warganegara Citizenship

Kelulusan Qualification

Pengalaman Bekerja (tahun) Working

Experience (Years) 1.

Nama/Name: No. K.P/Pasport: I.C/Passport No.

2.

5. Kurikulum/Kursus/Program/Latihan dan Yuran

Curriculum/Course/Programme/Training and Fee Structure Lengkapkan borang yang berkaitan : - Complete the relevant form : -

Borang 5A Form 5A

- Sekolah Rendah/Menengah/Rendah Agama Islam/Menengah Agama Islam Primary/Secondary/Islamic Primary/Islamic Secondary School

Borang 5B Form 5B

- Sekolah Antarabangsa/Ekspatriat International/Expatriate School

Borang 5C Form 5C

- Pusat Bahasa/Latihan Komputer/Kemahiran/Vokasional/Teknikal Language/Computer Training/Skill/Vocational/Technical Centre

Borang 5D Form 5D

- Pusat Perkembangan Minda Mind Enrichment Centre

Borang 5E Form 5E

- Pusat Bimbingan Guidance Centre

Borang 5F Form 5F

- Tadika Kindergarten

Borang 5G Form 5G

- Pusat Tuisyen Tuition Centre

Bil. No.


Warganegara Citizenship

Kelayakan Akademik Academic

Qualification

Kelayakan Ikhtisas

Profesional Qualification

Pengalaman Mengajar (tahun)

Teaching Experienc(Years)

1.

Nama/Name: No. K.P/Pasport: I.C/Passport No.

2.

3.

4.

5.


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Sertakan silibus kursus kecuali bagi Tadika, Sekolah dan Pusat Tuisyen yang menggunakan

Kurikulum Kebangsaan Attach course syllabus except for Kindergarten, School and Tuition Centre which is using the National Curriculum

6. Suratcara Pengelolaan Instrument of Governance

Sertakan draf Suratcara Pengelolaan tersebut Attach a draft of the Instrument of Governance

BAHAGIAN G : PREMIS DAN KEMUDAHAN SECTION G : PREMISE AND AMENITIES

1. Maklumat Premis

Information of Premise

a) Lokasi Premis Location of premise Bandar Town

Luar Bandar Rural

Pedalaman Interior


b) Jenis Premis Types of Premise


c) Pemilikan Ownership

Milik Sendiri Self Own

Sewaan/Pajakan Rent/Lease

Tanda(√) pada petak berkenaan. Sertakan salinan surat perjanjian jual beli Tick (√) the relevant box. Attach a copy of Sales and Purchase

Kampus Campus Balai Raya/Dewan Orang Ramai

Community/Multipurpose Hall

Bangunan Institusi Pendidikan Education Institutional Building Rumah Kedai

Shoplot

Kompleks Pejabat (selain sekolah dan tadika) Office Complex (other than school & kindergarten)

Rumah Kediaman (Tadika sahaja) Landed Residential Property (for Kindergarten only)

Kompleks Membeli-belah Shopping Complex Rumah Ibadat

House of Worship

Lain-lain, nyatakan Others, please state ....................................


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d) Sewaan Rental

Sertakan Perjanjian Sewaan/Surat Perakuan Sewaan Premis/Surat Tawaran Sewaan/Surat Pajakan Attach a copy of Rental Agreement/Letter of Acknowlegdement on Rental of Premise/Offer letter of intent to rent/Letter of Leasehold

Kaki Persegi Square feet Meter Persegi Square Metres

Sertakan salinan pelan lantai Attach a copy of the floor plan

Ekar Acres Hektar Hectares

Sertakan salinan master plan Attach a copy of the master plan

g) Butiran Premis:

Details of Premise:

Bil. No.

Kemudahan Pengajaran dan Pembelajaran Teaching and Learning Facilities

Bilangan Unit No. of Units

1. Bilik Darjah/Tutorial Classroom /Tutorial

2. Perpustakaan Library

3. Bilik Sumber Resource Room

4. Makmal Sains Science Laboratory

5. Makmal Komputer Computer Laboratory

6. Bengkel Kemahiran Hidup Living Skills Workshop

7. Auditorium Auditorium

8. Bilik Tarian Dancing Room

9. Bilik Media Media Room

10. Kemudahan lain, nyatakan Other facilities, please state ..............................................

Sewaan Sebulan Monthly Rental R M

.

0

0

e) Luas Lantai Premis Floor Area of Premise

f) Luas Tanah Land Area


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Bil. No.

Kemudahan Pentadbiran Administration Facilities


1. Bilik Pentadbiran/Pejabat Administration Room/Office

2. Bilik Guru Besar/Pengetua Head of School/Principal’s Rppm

3. Bilik Guru Teacher’s Room

4. Bilik Kaunseling Counselling Room

5. Bilik Mesyuarat Meeting Room

6. Dewan Hall


Bil. No.

Kemudahan Kokurikulum Co-curricular Facilities


1. Tapak Permainan Playground

2. Gimnasium Gymnasium

3. Padang Bola Sepak/Hoki Football/Hockey Field

4. Gelanggang Badminton Badminton Court

5. Gelanggang Tenis Tennis Court

6. Gelanggang Sepak Takraw Sepak Takraw Court

7. Gelanggang Bola Keranjang Basketball Court

8. Gelanggang Bola Tampar Volleyball Court

9. Gelanggang Skuasy Squash Court

10. Balapan Track

11. Gelanggang Futsal Futsal Court

12. Bilik Persalinan Changing Room

13. Kolam Renang Swimming Pool



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Sertakan lukisan arkitek bagi kategori sekolah sahaja Attach architect drawing for schools category only

BAHAGIAN H : LAIN-LAIN KELULUSAN SECTION H :OTHER APPROVED EDUCATIONAL INSTITUTION

1. Nyatakan kelulusan lain-lain IPS dan IPTS yang telah diberikan kepada pemohon di bawah Akta

Pendidikan 1996 (Akta 550) dan Akta Institusi Pendidikan Tinggi Swasta (Akta 555) Please state other PEI or PHEI that have been approved to the applicant under the Education Act 1996 (Act 550) and Private Higher Educational Institution Act 1996 (Act 555)

a. _______________________________________________________________________

b. _______________________________________________________________________

c. _______________________________________________________________________

Bil. No.

Kemudahan Keselamatan dan Kesihatan Security and Health Facilities


1. Pondok Pengawal Keselamatan Security Guard Booth

2. Bilik Sakit Sick Bay

3. Bilik Rawatan Treatment Room

4. CCTV


Bil. No.

Kemudahan-Kemudahan Lain Other Facilities


1. Tandas Lelaki Gents Toilet

2. Tandas Perempuan Ladies Toilet

3. Bilik Penyediaan Makanan Food Preparation Room

4. Tempat Makan/Kafeteria Pantry/Cafeteria

5. Surau Prayer Room (Muslim)

6. Tempat Menunggu Bas Bus Stop

7. Tempat Letak Kereta Parking Area



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BAHAGIAN I : PERAKUAN PEMOHON SECTION I : DECLARATION BY APPLICANT

Saya: ______________________________________ No. Kad Pengenalan: __________________ I (Nama pemohon dengan huruf besar) Identification Card No. (Applicant’s name in block letters)

Dengan sesungguhnya mengaku bahawa: Hereby, declare that:

a) Pernyataan-pernyataan yang terkandung dalam borang permohonan ini dan dokumen-dokumen yang dikepilkan adalah benar sepanjang pengetahuan dan kepercayaan saya; The statements mentioned in the application form and the documents attached are true to my knowledge and belief;

b) Tandatangan yang diturunkan pada borang permohonan ini adalah nama dan tulisan tangan saya yang sebenarnya; The signature and the name undersigned is mine;

c) Saya membuat pengakuan ini dengan penuh kepercayaan yang maklumat-maklumat yang diberi adalah benar dan menurut kandungan Akta Akuan Berkanun 1960 (disemak 1969); dan I declare in full belief that all of the information given is true and in accordance to the Statutory Act 1960 (revised 1969); and

d) Maklumat yang tidak benar/mengelirukan boleh menyebabkan permohonan ini ditolak.

Any information found to be untrue or misleading in this application may result in the applicationt to be rejected.

Cap Rasmi Official Stamp

________________________________ (Tandatangan Pemohon) (Signature of Applicant)

Nama Name

: ________________________________________

No. Kad Pengenalan Identity Card No.

: ________________________________________

Tarikh Date

: ________________________________________


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Borang 5A Form 5A

Sekolah Rendah/Menengah/Rendah Agama Islam/Menengah Agama Islam/Pendidikan Khas Primary/Secondary/Islamic Primary/Islamic Secondary/Special Education School


Bil. No.

Perkara Subject

Kenyataan Statement

1.

Kurikulum Curicullum

KSSR/KBSR KSSR/KBSR KBSM KBSM

2. Program Tambahan Additional Programme

Pendidikan Agama Islam Islamic Studies (Jabatan Agama Islam Negeri – JAIN) (State Islamic Religious Department – JAIN)

3.

Pengkhususan Pendidikan Khas Specialization Contoh: Example: Dyslexia,ADD, ADHD

Nyatakan Please state ......................................................

4. Aliran (KBSM) Stream (KBSM)

Sains Science Sastera Arts Teknikal Technical Vokasional/Teknologi Vocational/Technology Pendidikan Agama Islam Islamic Studies

5. Matapelajaran Kurikulum Kebangsaan dan Pendidikan Agama Islam National Curriculum and Islamic Studies subject

MATA PELAJARAN TERAS: CORE SUBJECTS: Bahasa Malaysia National Language Bahasa Inggeris English Matematik Mathematic Sains Science Pendidikan Agama Islam/Moral Islamic/Moral Studies Sejarah/Kajian Tempatan History/Local Studies


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Pendidikan Sivik dan Kewarganegaraan Civic and Citizenship Studies MATA PELAJARAN WAJIB: COMPULSORY SUBJECTS; Pendidikan Jasmani dan Kesihatan Health and Physical Education Kemahiran Hidup Living Skill Pendidikan Seni Arts Studies Pendidikan Muzik Music Geografi Geography

MATA PELAJARAN TAMBAHAN: ADDITIONAL SUBJECTS: Mandarin Mandarin Bahasa Tamil Tamil Bahasa Arab (Komunikasi) Arabic (Communication) Bahasa Pribumi Indigenous MATA PELAJARAN ELEKTIF: ELECTIVE SUBJECTS: Kumpulan 1: Kemanusiaan, nyatakan Group 1: Humanities, please state ...................................................... Kumpulan 2: Vokasional dan Teknologi, nyatakan Group 2: Vocational and Technology, please state ...................................................... Kumpulan 3: Sains, nyatakan Group 3: Sciences, please state ...................................................... Kumpulan 4: Pengajian Islam, nyatakan Group 4: Islamic Studies, please state ......................................................


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AGAMA ISLAM (JAIN), nyatakan Islamic (JAIN), please state ......................................................

6. Tahap dan tempoh pengajian Level and duration of studies

Tahun 1 – Tahun 6 (Tempoh 6 tahun) Year 1 – Year 6 ( 6 years duration) Tingkatan 1 – Tingkatan 5 (Tempoh 5 tahun) Form 1 – Form 5 (5 years duration) Tingkatan 1 – Tingkatan 6 (Tempoh 7 tahun) Form 1 – Form 6 (7 years duration) Kelayakan masuk adalah mengikut kohort umur persekolahan Kementerian Pelajaran Malaysia Admission is according to MOE’s schooling age cohort Kelayakam masuk bagi sekolah Pendidikan Khas adalah mengikut tahap pencapaian murid Admission into Special Education school is according to pupil’s achievement level

7. Persijilan Certification

Lembaga Peperiksaan Malaysia Malaysian Examination Syndicate Majlis Peperiksaan Malaysia Malaysian Examination Board Jabatan Agama Islam Negeri State Islamic Religious Department Sijil Kehadiran Attendance Certificate

8. Nisbah Kelas: Murid Class : Pupil Ratio


9. Bahasa Pengantar Medium of Instruction

Bahasa Kebangsaan National Language

10. Kokurikulum yang dicadangkan (minimum 1 daripada setiap kategori) Suggested Extra Co-Curricular Activities (minimum of 1 from each category)

Kelab dan Persatuan, nyatakan Clubs and Societies, please state ...................................................... Sukan dan Permainan, nyatakan Games and Sports, please state ...................................................... Unit Beruniform, nyatakan Uniformed Bodies, please state ......................................................


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Yuran Fees

1. Yuran Asas Basic Fees Pendaftaran (sekali sahaja) RM Registration (once only) Deposit (sekali dan dikembalikan) RM Deposit (once only and refundable) Yuran Pengajian (setahun) RM Tuition Fees (annually)

2. Bayaran Tambahan, jika ada Additional Fees, if any Yuran Komputer (setahun) RM Computer Fees (annually) Yuran Makmal (setahun) RM Laboratory Fees (annually) Yuran Perpustakaan (setahun) RM Library Fees (annually) Yuran Kokurikulum (setahun) RM Co-curricular Fees (annually) Makan Tengahari (setahun) RM Lunch (annually) Insuran/Majalah/Pengangkutan/Buku (setahun) RM Insurance/Magazine/Transportation/Books (annually) Lain-lain bayaran, nyatakan RM Other fees, please state ...............................................

3. Asrama, jika ada Boarding Fees, if any Bayaran Setahun RM Annual Fee Deposit (sekali dan dikembalikan) RM Deposit (once only and refundable) Makan (setahun) RM Meals (annually) Lain-lain bayaran, nyatakan RM Other fees, please state ...............................................


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Borang 5B

Form 5B Sekolah Antarabangsa/Ekspatriat

International/Expatriate School

Tandakan x dalam petak berkenaan Tick (√) the relevant box

Bil. No.

Perkara Subject

Kenyataan Statement

1.

Kurikulum Curriculum

2. Program Tambahan Additional Programme

3.

Bidang Field

Sains Sciences Sastera Arts Teknikal Technical Lain-lain, nyatakan Others, please state ..................................................

4. Tahap dan tempoh pengajian Level and duration of studies

Tahap Level

Tempoh Pengajian Duration of

studies

Umur Age

Tahap Pengajian

Level of studies

5. Peperiksaan dan Badan Persijilan Examination and Certification Body

Jenis Peperiksaan Types of Examination

Badan Persijilan Certification Body

6. Nisbah Ratio

Kelas : Murid Class : Pupils

Guru : Murid Teacher : Pupils

Sila rujuk contoh jadual di bawah Please refer to the

table below

Sila rujuk contoh jadual di bawah

Please refer to the table below


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Bahasa Inggeris English Lain-lain, nyatakan Others, please state ..................................................

8. Kokurikulum yang dicadangkan (minimum 1 daripada setiap kategori) Suggested Extra Co-Curricular Activities (minimum of 1 from each category)

Kelab dan Persatuan, nyatakan Clubs and Societies, please state ...................................................... Sukan dan Permainan, nyatakan Games and Sports, please state ...................................................... Unit Beruniform, nyatakan Uniformed Bodies, please state ......................................................

Contoh Jadual Tahap dan tempoh pengajian

Table of Level and duration of studies

Tahap Level

Tempoh Pengajian (Tahun) Duration

Umur (Tahun)

Age (Years)

Tahap Pengajian

Level of studies

Prep 1 – 2 2 4 – 5 Preparatory Year 1 – Year 6 6 6 – 11 Primary Year 7 – Year 9 3 12 – 14 Lower Sec.

Year 10 – Year 11 2 15 – 16 Upper Sec. Year 12 – Year 13 2 17 - 18 Post Sec.

Contoh Jadual

Peperiksaan dan Badan Persijilan

Table of Examination and Certification Body

Jenis Peperiksaan Types of Examination

Badan Persijilan Certification Body

IGCSE Cambridge IGCSE Edexcel

GCE ’O’ Level Cambridge ’A’ Level Edexcel

IB Diploma IBO


BORANG BPS I



Yuran Fees

1. Yuran Asas Basic Fees

Pendaftaran (sekali sahaja)

Registration (once only) RM

Deposit (sekali dan dikembalikan)

Deposit (once only and refundable) RM

Yuran Pengajian (setahun)

Tuition Fees (annually) RM

2. Bayaran Tambahan

Additional Fees

Yuran Tahunan

Annual Fee RM

Lain-lain bayaran, nyatakan

Other fees, please state RM

...............................................


BORANG BPS I



Borang 5C Form 5C

Pusat Bahasa/Latihan Komputer/Kemahiran/Vokasional/Teknikal Language/Computer Training/Skill/Vocational/Technical Centre

Tandakan x dalam petak berkenaan

Tick (√) the relevant box

Bil. No.

Perkara Subject

Kenyataan Statement

1.

Program Pogramme

Sendiri Home Grown MoU Franchise/Licensing Lain-lain, nyatakan Others, please state ......................................................

2.

Bidang Field

Bahasa Language Latihan Komputer Computer Training Kemahiran Skill Vokasional Vocational Teknikal Technical

3. Nama Program (Program mestilah tidak melebihi daripada 10) Name of Programme (Courses must not exceed 10)

i. .......................................................................... ii. .......................................................................... iii. ......................................................................... iv. .......................................................................... v. .......................................................................... Tempoh program tidak melebihi 3 bulan atau 300 jam Duration of programme must not exceed 3 months or 300 contact hours

4. Tahap Pengajian Level of Studies

Sijil Kehadiran Certificate of Attendance Kelayakan masuk adalah mengikut tahap pencapaian Admission is according to achievement level

5. Kelayakan masuk Admission



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Dalaman, nyatakan Internal, please state ...................................................... Luaran, nyatakan External, please state ......................................................



8. Bahasa Medium of Instruction

Bahasa Kebangsaan National Language Bahasa Inggeris English Bahasa Arab Arabic Bahasa Belanda Dutch Mandarin Mandarin Bahasa Jerman German Bahasa Jepun Japanese Bahasa Korea Korean Bahasa Peranchis French Bahasa Russia Russian Bahasa Tamil Tamil Bahasa Thai Thai Lain-lain, nyatakan Others, please state ......................................................


BORANG BPS I



Yuran Fees

Pendaftaran (sekali sahaja) RM Registration (once only) Deposit (sekali dan dikembalikan) RM Deposite (once only and refundable) Yuran Pengajian (satu kursus) RM Tuition Fee (per course) Lain-lain yuran, nyatakan RM Other fees, please state ...........................................


BORANG BPS I



Borang 5D Form 5D

Pusat Perkembangan Minda Mind Enrichment Centre Tandakan (√) pada petak berkenaan Tick (√) the relevant box

Bil. No.

Perkara Subject

Kenyataan Statement

1. Program Pogramme

Sendiri (telah mendapat Hak Cipta Terpelihara daripada Perbadanan Harta Intelek Home Grown (have obtained Intellectual Property Rights from MyIPO) MoU, nyatakan MoU, please state ...................................................... Francaisi/Licensing, nyatakan Franchising/Licencing, please state ......................................................

2.

Bidang Field

Bahasa Language Matematik Mathematics Lain-lain, nyatakan Others, please state .......................................................


4 tahun – 6 tahun 4 – 6 years old 7 tahun – 12 tahun 7 – 12 years old 13 tahun – 19 tahun 13 – 19 years old Lain-lain, nyatakan Others, please state ...................................................... Maksimum pengajaran dan pembelajaran tidak lebih daripada 3 jam sehari Maximum teaching and learning of 3 hours per day




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5. Persijilan

Certification Kepunyaan sendiri Self owned Luaran, nyatakan External, please state ......................................................




Bahasa Kebangsaan National Language Bahasa Inggeris English Mandarin Mandarin Bahasa Tamil Tamil Lain-lain, nyatakan Others, please state ......................................................

Yuran Fees

Pendaftaran (sekali sahaja) RM Registration (once only) Deposit (sekali dan dikembalikan) RM Deposite (once only and refundable) Yuran Pengajian (sila nyatakan secara terperinci) RM Tuition Fee (please state in detail) Lain-lain yuran, nyatakan RM Other fees, please state ...........................................


BORANG BPS I



Borang 5E Form 5E

Pusat Bimbingan (Khusus untuk murid tanpa dokumen) Guidance Centre (Specifically for non-documented pupils)


Bil. No.

Perkara Subject

Kenyataan Statement

1. Program Programme

Program berasaskan KSSR Programme is based on KSSR Lain-lain, nyatakan Others , please state ......................................................

2. Bidang Field

Akademik Academic Kemahiran Skill Lain-lain, nyatakan Others , please state ......................................................

3. Matapelajaran Subjects

Bahasa Kebangsaan National Curriculum Bahasa Inggeris English Matematik Mathematics Sains Science Pendidikan Agama Islam/Moral Islamic/Moral studies Sejarah/Kajian Tempatan History/Local Studies Lain-lain, nyatakan Others , please state ......................................................


Mengikut tahap pencapaian According to the level of achievement Lain-lain, nyatakan Others, please state ......................................................


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5. Persijilan

Certification

Dalaman, nyatakan Internal, please state ......................................................



7. Bahasa pengantar Medium of Instruction

Bahasa Kebangsaan (wajib) National Language (Compulsoory) Lain-lain, nyatakan Others, please state ......................................................

Yuran Fees

Pendaftaran (sekali sahaja) RM Registration (once only) Deposit (sekali dan dikembalikan) RM Deposite (once only and refundable) Yuran Pengajian RM Tuition Fee Lain-lain yuran, nyatakan RM Other fees, please state ...........................................


BORANG BPS I



Borang 5F Form 5F

Tadika Kindergarten


Bil. No.

Perkara Subject

Kenyataan Statement

1.

Kurikulum Curicullum

Kurikulum Standard Pra Sekolah wajib Kebangsaan (KSPK) Pre School Standard Curicullum compulsory

2. Program tambahan, jika ada Additional programme, if any

Program Franchise/Licensing Franchise/Licencing Programme Nyatakan Please state ......................................................


Umur 4 tahun – 6 tahun 4 – 6 years old Minimum pengajaran dan pembelajaran KSPK tidak kurang daripada 4 jam sehari Minimum teaching and learning of 4 hours per day Kelayakan masuk adalah mengikut kohort umur persekolahan Kementerian Pelajaran Malaysia Admission is according to MOE’s schooling age cohort


Kepunyaan sendiri Self owned Luaran, nyatakan External, please state ......................................................


Dalaman, nyatakan Internal, please state Luaran, nyatakan External, please state




Bahasa Kebangsaan National Language Bahasa Inggeris English Mandarin Mandarin Bahasa Tamil Tamil Lain-lain, nyatakan Others, please state ......................................................


BORANG BPS I



Yuran Fees

Pendaftaran (sekali sahaja) RM Registration (once only) Deposit (sekali dan dikembalikan) RM Deposite (once only and refundable) Yuran Pengajian (setahun) RM Tuition Fee (annually) Makan (setahun) RM Meals (annually) Pakaian seragam sekolah RM Uniform Lain-lain yuran, nyatakan RM Other fees, please state ...........................................


BORANG BPS I



Borang 5G Form 5G

Pusat Tuisyen Tuition Centre


Bil. No.

Perkara Subject

Kenyataan Statement

1.

Kurikulum Curriculum

KSSR/KBSR KSSR/KBSR KBSM KBSM

2. Matapelajaran Subjects

Bahasa Kebangsaan National Curriculum Bahasa Inggeris English Matematik Mathematics Matematik Tambahan Additional Mathematics Sains Am General Science Biologi Biology Kimia Chemistry Fizik Physics Sejarah Subject Geografi Subject Mandarin Mandarin Bahasa Tamil Tamil Bahasa Arab Arabic Lain-lain, nyatakan Others , please state ......................................................


BORANG BPS I



3. Tahap pengajian

Level of studies Tahun 1 – Tahun 6 Year 1 – Year 6 Tingkatan – Tingkatan 6 Form 1 – Form 6



5. Bahasa pengantar Medium of instruction

Bahasa Kebangsaan National Language Lain-lain, nyatakan Others , please state ......................................................

Yuran Fees

Pendaftaran (sekali sahaja) RM Registration (once only) Deposit (sekali dan dikembalikan) RM Deposite (once only and refundable) Yuran Pengajian RM Tuition Fee Lain-lain yuran, nyatakan RM Other fees, please state ...........................................


BORANG BPS I



SENARAI SEMAK CHECKLIST Tandakan (√) pada petak berkenaan Tick (√) the relevant box Bersama-sama ini disertakan salinan: Attached the following copies of certified documents: Bil. No.

Keperluan Needs

Tandakan Tick

1. Borang BPS 1 yang telah lengkap diisi Completed Form BPS 1

2. Salinan Kad Pengenalan/ Pasport Pemohon A copy of Applicant’s Identity Card or Passport

3. Salinan Sijil (SSM) atau Dokumen perniagaan/syarikat/pertubuhan/persatuan/ yayasan/koperasi A copy of Registration Certificate (CCM)or Approval Letter of business / company / organization/society/foundation/cooperative

4. Salinan Borang 24 dan Borang 49 Pendaftar Syarikat (yang disahkan oleh SSM) Salinan Borang A dan Borang B Pendaftar Perniagaan A copy of Form 24 and Form 49 ROC A copy of Form A and Form B ROB Nota: Note - 30% Ekuiti Bumiputra 30% Native’s Equity - Ekuiti luar Negara diantara 20% - 51% bergantung kepada Negara (FTA) Foreign equity between 20% - 51% depending on countries (FTA)

5. Modal Berbayar (Minimum): Tadika dan Pusat Tuisyen: RM10,000.00 Semua Kategori Sekolah: RM100,000.00 IPS Lain-lain: RM50,000.00 Paid-Up Capital (Minimum): Kindergarten and Tuition Centre: RM10,000.00 All Categories of School: RM100,000.00 Other PEI: RM50,000.00

6. Salinan Memorandum and Articles (M&A) A copy of M&A

7. Salinan Laporan Kewangan Tahunan A copy of Annual Financial Report

8. Salinan Minit Mesyuarat Agong (Pertubuhan/Persatuan/Yayasan/Koperasi) A copy of Annual General Meeting (Organisation/Society/Foundation/Cooperative)

9. 3 nama IPS yang dicadangkan di dalam Bahasa Kebangsaan Suggested 3 names for PEI in National Language

10. Surat Sokongan pihak Berkuasa Tempatan (Untuk kategori sekolah, pusat tuisyen dan tadika) A copy of Supporting Letter from the relevant Local Authority/Council (For school, tution centre and kindergarten category)

11. Bagi Tadika - Surat Persetujuan Jiran-Jiran terdekat For Kindergartens – Consent letter from the neighbours

12. Pengerusi Lembaga Pengelola Maklumat diri (CV) Salinan Kad Pengenalan/Pasport Salinan Sijil/Diploma/Ijazah Surat lantikan

Chairman of The Board of Governors Curiculum Vitae A copy of Identity Card/Passport


BORANG BPS I



A copy of Certificate/Diploma/Degree Appointment Letter

13. Lembaga Pengelola Institusi: (Minimum 5 orang termasuk Pengerusi Lembaga Pengelola. Guru Besar/ Pengetua tidak boleh menjadi pengerusi atau ahli Lembaga Pengelola kerana beliau secara automatik bertndak sebagai setiausaha Lembaga Pengelola institusi berkenaan) Maklumat diri (CV) Salinan Kad Pengenalan/Pasport Salinan Sijil/Diploma/Ijazah Board of Governers: (Minimun of 5 persons including the Chairman. The Head Teacher /Principal is not allowed to be the Chairman or a member to the BoG because he/she acts as the secretary to the BoG of the institution. ) Curriculum Vitae A copy of Identity Card/Passport A copy of Certificate/Diploma/Degree

14. Guru Besar/Pengetua Maklumat diri (CV) Salinan Kad Pengenalan/Pasport Salinan Sijil/Diploma/Ijazah Head Teacher/Principal Curriculum Vitae A copy of Identity Card/Passport A copy of Certificate/Diploma/Degree

15. Guru Maklumat diri (CV) Salinan Kad Pengenalan/Pasport Salinan Sijil/Diploma/Pasport Teachers Curriculum Vitae A copy of Identity Card/Passport A copy of Certificate/Diploma/Degree

16. Draf Surat Cara Pengelolaan A draft of Instrument of Governance

17. Silibus Syllabus

18. Salinan surat perjanjian jual beli (jika premis milik sendiri) A copy of sales and purchase agreement (if self ownership)

19. Salinan surat perjanjian sewaan/pajakan ( jika menyewa) A copy of rental/lease agreement (if rental)

20. Pelan lokasi Location Plan

21. Pelan lantai premis Floor Plan

22. Salinan pelan tapak (sekolah sahaja) A copy of site plan (school only)

23. Lukisan arkitek (sekolah sahaja) Architect drawing (school only)

24. Borang 5A/5B/5C/5D/5E/5F/5G Form 5A/5B/5C/5D/5E/5F/5G

Nota: Jika Pengerusi/Ahli Lembaga Pengelola/Guru Besar/ Pengetua /Tenaga Pengajar adalah kakitangan kerajaan, sila kemukakan Surat Kebenaran daripada majikan tempat mereka bertugas Note If the Chairman/Members of BOG Head Teacher/Principal/ /Teachers is a government servant, please

submit Approval Letter from the Head of Department.

borang bps i permohonan penubuhan institusi...

Documents